=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033549589
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH R SHAPIRO MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2013
-----------------------------------------------------
Last Update Date | 11/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12660 RIVERSIDE DR SUITE 325
-----------------------------------------------------
City | STUDIO CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-769-5998
-----------------------------------------------------
Fax | 818-769-5004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12660 RIVERSIDE DR SUITE 325
-----------------------------------------------------
City | STUDIO CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91607-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-769-5998
-----------------------------------------------------
Fax | 818-769-5004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | JOSEPH ROBERT SHAPIRO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-769-5998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | A77622
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------